RC_Rx_Qualify Medication request by id (modified - ENG)

Specification 

Apiary

Purpose

This WS is designed to qualify Medication request (post) - check the ability of using Medication request within the Medication program and receive program participants.

Input parameters (filters)

• id 

• ARRAY [program] (mandatory)

Authorize

1. Verify the validity of access token

2. Check user scope (scope = 'medication_request:details') in order to perform this action

   1. In case error - generate 401 response

Validate request (JSON schema)

Validate request using JSON schema 

Validate FK

1. Validate id - medication_request_id exists

   1. Return  404 in case (not found medication request in DB with this ID)

2. Validate [programs.id] - medical programs id  exists

   • Return 422 in case validation fails (422 EView - not found medical program in DB with this ID)

Get Medication Request 

Invoke Get Medication request by ID 

Validation status

1. For info - status charts: Medication_request

2. Check Medication Request `status` = ACTIVE
   
   

   1. if invalid - return 409 error (message: "Invalid status Medication request for qualify action!")'

Validate related Care plan

If medication_request.based_on is present and not null:

1. Verify Care plan:

   1. It should be in active status

      1. in case of error - return 409 (message: "Invalid care plan status")

   2. Care plan's period end (if exist) should be greater than current date or equal.

      1. in case of error - return 409 (message: “Care plan expired“)

2. Verify care plan Activity:

   1. It has scheduled, in_progress status

      1. in case of error - return 409 (message: "Invalid activity status")

Validate division

1. Validate division is active

   1. in case of error - return 409 ("Division is not active")

2. Validate division belongs to user's legal entity

   1. in case of error - return 409 ("Division does not belong to user's legal entity")

3. If chart parameter DISPENSE_DIVISION_DLS_VERIFY is on, then validate division is DLS verified (dls_verified=true)

   1. in case of error - return 409 "Division is not verified in DLS"

4. Check division participates in submitted programs. Validate Provision for each Medical Program:

   1. If the medical program has no setting skip_contract_provision_verify or it is equal to false/null:

      1. if medical program in the request has funding_source one of NHS, LOCAL

         1. In case of error - return status=INVALID for a program, rejection_reason="Program was configured incorrectly. Either incorrect source of funding or option skip_contract_provision_verify"

      2. provision exist and active for the division:

         1. in case of error - return status=INVALID for a program, rejection_reason= "Division does not provide the medical program"

      3. if medical program in the request has funding_source = NHS:

         1. provision relates to the actual reimbursement contract: contract.start_date <= current_date <= contract.end_date, is_active = true, status = VERIFIED, contracts.type==reimbursement, contracts.contractor_legal_entity_id=token.client_id, contracts.medical_program_id==$.medical_program_id

            1. in case of error - return status=INVALID for a program, rejection_reason="Medical program provision is not related to any actual contract for the current date"

         2. contract is_suspended = false

            1. in case of error - return status=INVALID for a program, rejection_reason="Contract with number <contract_number> is suspended"

      4. if medical program in the request has funding_source = LOCAL, then check medical_program_provision.msp_legal_entity_id = medication_request.legal_entity_id

         1. in case of error - return status=INVALID for a program, rejection_reson = "Medical program can not be provided for the legal entity specified in the medication request"

   2. else if skip_contract_provision_verify = true, then skip provision verification for the medical program

5. Get license_types_allowed parameter from settings of medical program from request $.medical_program_id:

   1. if it is exists and not empty, get list of all license types from parameter.
      Check that division has active healthcare services with following parameters:
      
      

      1. legal_entity_id = client_id from access token

      2. division_id = division_id from request

      3. status = 'ACTIVE'

      4. licensed_healthcare_service.status = 'ACTIVE'

      5. healthcare_service.license_id is not null and licenses.type = value from license_types_allowed parameter

         1. in case of error - return status=INVALID for a program, rejection_reason = 'Division does not have active licenses to provide the medical program'

Logic for qualify (analyze compliance with programs)

• Each Medical program may have its unique conditions for the medication dispense. It can be based on analysis of personal info, medications list, terms, locations and combinations of them.

• For now there are only conditions for the following programs "Dostupni liky", "Netsukrovyy diabet", "Insuliny z doplatoyu", "Insuliny bezoplatno" and we check them.

• Also, it is possible to have the medication dispense without any Medical program.

• However for any Medical program we need a separate block of branching logic.

• Check compatibility only for programs which are available in payload (array)

• If program status is invalid, the reason must be saved and returned in response

Check compliance for programs

1. Validate 2 checks (below in the text) for programs

   1. if passed - save status this program for response = VALID

Check INNM_dosage compliance for the programs

Applies to the following programs:

1. Dostupni liky

2. Netsukrovyy diabet

3. Insuliny z doplatoyu

4. Insuliny bezoplatno

Validation purpose:  There is a list of medications (which links to innm_dosage) which can be used for the program. It must be check whether there is at least one available medication for the innm_dosage for the particular program.

1. Get info from Medication request  by id in payload, set temp variable object `_MR`

2. Validate the compatibility of innm with the medication program list 

   1. if data is not found:

      1. add to response: status = INVALID

      2. add to response: rejection_reason = "Innm not on the list of approved innms for program '#{program.name}"

Check absence a same medication for the programs

Applies to the following programs:

1. Dostupni liky

2. Netsukrovyy diabet

3. Insuliny z doplatoyu

4. Insuliny bezoplatno

Validation purpose: It could be done several dispenses for one medication request per one innm for one patient until sum(medication_dispenses.medication_qty) < medication_request.medication_qty

Example validation: without crossing time

1. For info - status charts: Medication Request Status Chart & Medication Dispense Status Chart

2. Get `check_innm_id`

   SELECT I.innm_child_id     FROM ingredients I WHERE I.parent_id = _MR.medication_id     AND I.is_primary = TRUE

3. Get Medication requests with their linked completed Medication dispense by person_id & innm_id

   SELECT * FROM medication_requests MR    INNER JOIN medication_dispense MD        ON MD.medication_request_id = MR.id             AND MD.status IN (PROCESSED)    INNER JOIN ingredients I        ON I.parent_id = MR.medication_id           -- type = INNM_DOSAGE            AND I.innm_child_id = `check_innm_id`            AND I.is_primary = TRUE    WHERE MR.person_id == _MR.person_id        AND MR.status IN (ACTIVE, COMPLETED)        AND NOT($.started_at> MR.ended_at OR $.ended_at < MR.started_at)

4. Validate medication request_id
   
   

   1. for medication_dispense.medication_request_id !== $.id

      1. Validate exist (IF EXIST ()  - that is any crossing  calculating term (started_at + ended_at) for payload with terms selecting Medication requests with linked Medication dispense (started_at + ended_at)).  

      2. if found 

         1. get $.medical_programs.medical_program_setting by medical_program_id from request

            1. validate skip_mnn_in_treatment_period variable

               1. in case skip_mnn_in_treatment_period == FALSE (or absent) 

                  1. validate request according to logic:

                     1. add to response: status = INVALID

                     2. add to response: rejection_reason = "For the patient at the same term there can be only 1 dispensed medication request per one and the same innm!"

               2. in case skip_mnn_in_treatment_period == TRUE

                  1. skip validating frequency of receiving drugs

   2. for medication_dispense.medication_request_id = $.id

      1. Validate medication request qty: sum(medication_dispenses.medication_qty) >= medication_request.medication_qty 

      2. if found

         1. add to response: status = INVALID

         2. add to response: rejection_reason = "Sum of dispense's medication quantity can not be more then medication_request.medication_qty"

Generate structure for response

• Collect response array for all programs in payload with status for each (VALID or INVALID) and rejection_reason

• For all VALID programs - Get linked medications (type = BRAND) with reimbursement info 

• Show only active program medications based on start_date and end (start_date must be earlier or equal to current date or empty, end_date must be greater or equal to current date or empty)

  • Filter participants simultaneously by container_dosage and max_request_dosage

Prepare & return response data structure

Fill response WS data structure

1. Validate response using JSON schemas

   1. Return 422 with list of validation errors in case validation fails (422 EView)